중소병원 적정성 평가 개선방안

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의료질적정성 평가병원급 의료기관
Quality assessment has been launched for hospitals from 2019 by Health Insurance Review and Assessment Agency (HIRA). The assessment includes indexes for doctors, nurses, beds, visitor management, infection control, and patient safety which can be applied to all hospitals. However, the assessment does not deal with doctors’ practices. This study was conducted to develop the new assessment plan for hospital quality.
We reviewed the overall areas of quality assessment by HIRA including the first quality assessment for hospitals. In additions, some strategies for quality assessment in health care from USA, Australia and Canada were summarized including quality indicators. Also, we checked other quality measures which were used for various objectives in health care in Korea.
We found the levels of quality in hospitals were relative lower than the levels in general or tertiary teaching hospitals. In addition, the areas of quality assessment has focused on the field with high mortality and costly issues which are not relevant with hospitals. Osteopedics, psychiatry, obstetrics, pediatrics, rehabilitation are main departments for hospitals. Therefore, we tried to find quality indicators on these areas. Moreover, quality assessment areas were checked which have dealt with hospitals such as hypertension, homodialysis, and so on. Efficiency indicators such as length of stay and national spending were also considered for new indicators.
Finally, the new quality assessment plan for hospital have developed including common indicators which were used in the first assessment and newly developed. In addition, specific indicators were also included in this plan which were used previous quality assessment such as hypertension, homodialysis and so on and new indicators for healthcare delivery system,
knee and hip replacement, vertebral surgery, rehabilitation, obstetrics, colorectal and anal surgery. We also suggests patient reported outcome indicators in the near future. This system adopted absolute evaluation system and financial and non-financial support like a pay for report and pay for performance. We hope that this system will be helpful to improve quality in healthcare for hospital.
Table Of Contents
요약 ···························································································· ⅰ

제1장 서론 1
1. 연구 배경 ······························································································ 3
2. 연구 목적 ···························································································· 13
3. 연구내용 및 방법 ················································································· 14

제2장 평가 현황 파악 및 한계점 분석 21
1. 적정성 평가제도 현황 ··········································································· 23
2. 2019년 1차 중소병원 적정성 평가 ························································ 40

제3장 해외 의료기관 평가제도 고찰 51
1. 미국 ···································································································· 53
가. CMS의 질 보고 및 가치기반 프로그램 ······················································· 53
나. CMS의 병원 질 개선 활동 ········································································ 55
다. CMS의 Measure Inventory Tool ···························································· 56
라. International Consortium for Health Outcome Measurement (ICHOM) ··· 59
2. 캐나다 ································································································· 61
3. 호주 ···································································································· 66
가. 성과 및 책임 체계 ···················································································· 66
나. Australian Health Performance Framework ··········································· 71
다. Performance Monitoring Framework 2019-20 ······································ 78

제4장 병원급 의료기관 평가체계(안) 91
1. 병원급 의료기관 유형분류 ····································································· 93
가. 중소병원 개념 및 유형분류의 필요성 ························································· 93
나. 유형의 분류 및 이용시 고려사항 ······························································ 101
다. 병원급 의료기관 유형분류 활용안 ····························································· 103
2. 평가 지표 ·························································································· 105
가. 공통지표 ································································································ 105
나. 진료영역별 평가지표 ·············································································· 109
다. 유형분류에 따른 평가지표 구성안 ····························································· 164
라. 평가지표 구성에 따른 병원급 의료기관 하위항목 적용 분포 ························ 165
3. 신규 평가체계(안) ··············································································· 173
가. 병원급 의료기관 新적정성 평가 체계 ························································ 173
나. 추가적인 고려사항 ·················································································· 178
다. 향후 발전방안 ························································································ 186
4. 결론 ·································································································· 188
가. 개선방향 ································································································ 188
나. 지원방향 ································································································ 188

◾ 참고 문헌 ····················································································· 189
◾ 부록 ····························································································· 191
◾ ABSTRACT ················································································· 263
조민우. (2022-12). 중소병원 적정성 평가 개선방안.
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